MPI

Question 1

coronary artery disease

Answer 1

• decrease in blood flow to heart due to atherosclerotic plaque, or occlusive thrombus/embolism

Question 2

where is plaque likely to form?

Answer 2

in a bend or bifurcation in the coronary artery
- where there are more blood turbulence occurring

Question 3

what contributes to CAD?

Answer 3

• HTN, hyperlipidemia, diabetes, smoking, obesity, diabetes, sedentary lifestyle, family hx, gender

Question 4

how does plaque formation occur?

Answer 4

1. injury - damage to inner lining of blood vessels
2. healing
3. localization of macrophages and smooth muscles
4. plaque progresses

Question 5

how does plaque progression occur?

Answer 5

1. fibrous tissue deposition (fibrous cap)
2. calcium deposition

Question 6

how do drugs reduce the size of plaque?

Answer 6

1. by reducing lipids in plaque
2. increasing lipids out of the plaque
3. limit number of macrophages present

Question 7

what drugs are used for plaque reduction?

Answer 7

statins
Lipitor, Crestor, Zocor

Question 8

which wall will be seen to have more uptake?

Answer 8

lateral > ant or inf

Question 9

normal LHR when using 201Tl

Answer 9

<0.5:1

Question 10

normal TID

Answer 10

stress:rest
~1

Question 11

normal summed stress score (SSS)
normal summed rest score (SRS)

Answer 11

<4
<4

Question 12

normal LVEF

Answer 12

> 50%

Question 13

stress/rest matched with NO defects

Answer 13

normal
but watch out for triple vessel disease

Question 14

stress/rest mismatched defects

Answer 14

stressed induced reversible myocardial ischemia

Question 15

stress/rest matched defects

Answer 15

chronic hibernating myocardium
/ myocardial infarction

Question 16

what is triple vessel disease?

Answer 16

stenosis in all major coronary arteries = overall decreased perfusion making it look normal

Question 17

what pathological conditions will make it easier to see the ischemic myocardium?

Answer 17

when one vessel is affected significantly more than the others

Question 18

when does sensitivity increase for ischemic myocardium?

Answer 18

when two obstructed vessels “watersheds” affect the same portion of myocardium

Question 19

TID >1.4

Answer 19

multi-vessel disease

Question 20

polar plots

Answer 20

semi-quantitative method of analyzing regional perfusion
- data obtained is compared to a large database of normal

Question 21

increase Rt:Lt ventricular uptake ratio to indicate CAD

Answer 21

> 0.42

Question 22

summed stress score indicating mild risk

Answer 22

4-8

Question 23

summed stress score indicating moderate risk

Answer 23

9-13

Question 24

summed stress score indicating severe risk

Answer 24

> 13

Question 25

low SDS is due to...

Answer 25

matched SSS and SRS

Question 26

what does low SDS indicate?

Answer 26

irreversible

Question 27

large SDS =?

Answer 27

mismatched SSS and SRS

Question 28

SSS scoring is created by...

Answer 28

infarcts or stress induced ischemia

Question 29

SDS scoring is created by...

Answer 29

fixed perfusion defects or hibernating myocardium caused by chronic ischemia

Question 30

stunned myocardium

Answer 30

acute + temporary - after acute ischemic event tissue viable but function and contractility is diminished

Question 31

what does a stunned myocardium look like on a NM scan?

Answer 31

normal perfusion but poor ventricular contraction

Question 32

how do you treat stunned myocardium?

Answer 32

it should spontaneously resolve after a few weeks!

Question 33

hibernating myocardium

Answer 33

chronic ischemia caused by severe coronary artery stenosis no perf on rest, fill in on redistribution images

Question 34

201Tl perf stress: normal redistribution: normal 24hr delay: n/a interpretation?

Answer 34

neg for cad

Question 35

201Tl perf stress: abnormal redistribution: normal 24hr delay: n/a interpretation?

Answer 35

ischemia

Question 36

201Tl perf stress: abnormal redistribution: abnormal 24hr delay: normal interpretation?

Answer 36

chronic ischemia/hibernating myocardium

Question 37

201Tl perf stress: abnormal redistribution: abnormal 24hr delay: abnormal interpretation?

Answer 37

non-viable/infarct/scar

Question 38

201Tl viability rest: normal redistribution: n/a interpretation?

Answer 38

viable myocardium

Question 39

201Tl viability rest: abnormal redistribution: normal interpretation?

Answer 39

viable/hibernating myocardium

Question 40

201Tl viability rest: abnormal redistribution: abnormal interpretation?

Answer 40

non-viable myocardium